Noel Gaelle, Harimanana Aina, Borand Laurence, Campana Florence, Leng Chanthy, Botr Chhunly, Rafetrarivony Lala, Rajabizadeh Mahdi, Kerleguer Alexandra, Dim Bunnet, Randriamoramanana Anny M, Ait-Ahmed Mohand, Guiso Nicole, Collard Jean-Marc, Taieb Fabien
Center for Translational Science, Institut Pasteur, Paris cité University, Paris, France.
Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
BMC Infect Dis. 2025 Feb 28;25(1):287. doi: 10.1186/s12879-025-10590-6.
Reliable data on whooping cough, a highly contagious disease sometimes fatal for infants, are largely lacking in low- and middle-income countries.
We conducted a hospital-based prospective study (PS) on infants, and a household contact-case investigation (CCI) for positive cases throughout Cambodia and in the city of Antananarivo, Madagascar, between 2017 and 2019. The PS, in which Bordetella diagnostics (qPCR) were performed, included infants aged ≤6 months presenting with ≥5 days of cough associated with one pertussis-like symptom. CCI was performed using qPCR and serology regardless of clinical signs.
In this study, 207 and 173 participants from Cambodia and Antananarivo were respectively enrolled. Respectively 26.1% (54/207) and 22.0% (38/173) of the infants were infected in the cohorts from Cambodia and Antananarivo. Cough longer than 10 days appeared as a risk factor in both countries, as well as coughing spells, apnea and normal pulmonary auscultation, having a coughing contact in Cambodia. In Antananarivo, being clinically well between coughing spells appeared as a risk factor. Five infants, all positive, died during the study. In Cambodia and Antananarivo respectively, 50.9% (118/232) and 67.8% (82/121) of the contact cases were positive. Respectively 94.4% (51/54) and 90.3% (28/31) of the households had at least one positive contact case.
The data show that pertussis circulates at high levels among infants and in their households both in Cambodia and in Antananarivo. Given the vulnerability of youngest infants, who are too young to receive fully primary vaccination, they need to be protected through boosters breaking transmission chains. Molecular diagnosis, as well as trained medical human resources to detect the disease early, are absolutely key to protect populations.
在低收入和中等收入国家，关于百日咳这种对婴儿有时具有致命性的高度传染性疾病的可靠数据非常缺乏。
2017年至2019年期间，我们在柬埔寨以及马达加斯加的塔那那利佛市针对婴儿开展了一项基于医院的前瞻性研究（PS），并对确诊病例进行了家庭接触者病例调查（CCI）。PS研究中进行了博德特氏菌诊断（定量聚合酶链反应），纳入了年龄≤6个月、咳嗽≥5天且伴有至少一种百日咳样症状的婴儿。无论临床症状如何，CCI均采用定量聚合酶链反应和血清学检测。
本研究中，分别有207名和173名来自柬埔寨和塔那那利佛的参与者入组。柬埔寨和塔那那利佛队列中的婴儿感染率分别为26.1%（54/207）和22.0%（38/173）。在这两个国家，咳嗽超过10天、咳嗽发作、呼吸暂停以及肺部听诊正常且在柬埔寨有咳嗽接触史均表现为危险因素。在塔那那利佛，咳嗽发作间歇期临床状况良好也表现为危险因素。研究期间有5名婴儿死亡，均为阳性病例。在柬埔寨和塔那那利佛，接触者病例的阳性率分别为50.9%（118/232）和67.8%（82/121）。分别有94.4%（51/54）和90.3%（28/31）的家庭至少有一例接触者阳性病例。
数据表明，百日咳在柬埔寨和塔那那利佛的婴儿及其家庭中均呈高传播水平。鉴于最小的婴儿过于年幼无法完全接种初级疫苗，易受感染，因此需要通过加强免疫来打破传播链以保护他们。分子诊断以及训练有素的医疗人力资源以便早期发现疾病，对于保护人群绝对至关重要。
